| NPI | 1750014288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-19529) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A23762) |
| 207Q00000X Family Medicine (Licence: MS 33817) | |
| Enumeration Date | 2022-07-01 |
| Last Update Date | 2025-09-22 |